COVID Expert Dr. Hotez On His Own Positive Case: What He’s Learned

Dr. Peter Hotez

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Marianne O’Hare : Welcome to Conversations on health care. This week we welcome
renowned vaccine and infectious disease expert, Dr. Peter Hotez on
the Omicron sub variant drive n COVID surge, vaccine efficacy, and
confronting the anti - science movemen t.

Dr. Peter Hotez: I worry that this vaccine resistance refusal is not going to halt at
COVID - 19 vaccinations but is going to become more universal
phenom enon on childhood vaccinations.

Marianne O’Hare : Lori Robertson checks in from F act C heck.org and we e nd with a bright
idea improving health and well being in everyday lives. Now, here are
your hosts Mark Masselli and Margaret Flinter.

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Mar k Masselli: Our guest is a renowned vaccine developer and pediatric infectious
disease expert, who has been nom inated for the Nobel Peace Prize ,
but now he's battling his own case of breakthrough COVID .

Margaret Flinter: Dr. Peter Hotez is acclaimed for helping to create a patent free COVID -
19 vaccine. It's been called the world's vaccine. Dr. Hotez joins us
from T exas Children's Hospital Center for Vaccine Development at the
Baylor College of Medicine.

Mark Masselli: Dr. Hotez, we saw you at the beginning of the year and thank you for
being back. But we understand you're testing positive for COVID,
nearly 60% of Am ericans have caught the virus, including most
children according to the CDC . How are you feeling and tell us about
your treatment?

Dr. Peter Hotez: Well, I'm feeling good. I'm on Paxlovid and I think one of the reasons
I'm doing well is because I'm fully v accinated and double boosted so
that's the difference between being in a hospital bed and speaking to
you on Zoom comparing bow ties and so doing quite well which I
attribute primarily to the vaccination although probably the Paxlovid
is helping well, so a little bit of headache and sore throat and some
congestion, but overall doing pretty well, and which I attribute to the
modern miracles of science.

Mark Masselli: We're glad to hear that.

Margaret Flinter: Absolutely. And Dr. Hotez thanks for joining us i n the middle of all
this, and I will say I'm very glad we're living in 2022 now and not 2020
pre - vaccine pre - Paxlovid, but there's op - ed in Stat from a primary
care doctor that says, well, there was only a single trial for the drug
that included only unvac cinated people. This primary care doctor says
he's left guessing if it'll help vaccinated people like you. What are your
thoughts on that subject?

Dr. Peter Hotez

Dr. Peter Hotez: Well, it should, it should help vaccinated individuals. I'm wondering if ,
you know, sometime s when you're trying to release for emergency
use authorization, it's sometimes difficult to get all of the I 's dotted
and T's crossed when you're moving quickly. But I think it's a good
drug . The evidence was pretty solid. There's no reason why I believe it
would not work well. And I think the bigger issue is given this BA.2.12
the approval and all the clinical trials were done before BA.2.12 hit
and maybe that's the game changer. That the amount of virus and
virus replication is much higher and so potenti ally we need a longer
course of treatment than five days b ecause there's right now a
number of relapses. In other words, you take that five day course ,
yo u're feeling better, you finish, you test negative, and then a number
of people are now turning positi ve agai n, and having rebound
symptoms. In some cases, the rebound symptoms are worse than the
original. And that was seen about 1% to 2% of the time in the clinical
trials. Anecdotally, it's happe ning at a much higher frequency now. So
I understand the Nat ional Institutes of Health and the Center s for
Disease Control and the Food Drug Administration are all looking into
it right now and hopefully soon we'll have some answers there.

Mark Masselli: It seems to be understandable on emergency use authorization but
we don't seem to have a lot of data from the CDC about what are we
seeing in terms of who's in that hospital, more likely people who
haven't been vaccinated . We're just not seeing a lot of information on
strategies to avoid the vaccine , w hat's the real chance outdoors , c an I
go inside with a mask and have dinner if I just keep my mask on , and it
seems like we have a paucity of data on people's experience from the
CDC. What's your thought about w hat's lacking here or is this the best
we can get?

Dr. Pete r Hotez: I think what's missing is we don't give accurate and timely advice
based on community levels of transmission. And that's what it comes
down to whether or not you can go to an indoor gathering safely or
eat in a restaurant safely . It very much depe nds, I think, on levels of
community transmission. So when we were in nadir or when we're in
between waves, I think there's a lot more we can do we have a lot
more flexibility than when you're starting to see a big wave
accelerate. That's point one. So for instance, when you're on the
upswing of the Omicron wave, which was the worst in terms of
number of new cases, we saw lots of people getting infected even
with breakthrough infection, although those were not as severe as
opposed to on the downside of thin gs. And I think the same is true
right now for this BA.2.12 c urrent wave . When it started, I was kind of
hope ful that there will be some pre - existing immunity with Omicron,
as well as the people who were vaccinated , so it’d be more than a
bump than a wave. And indeed, you didn't see the numbers going up
very precipitously. So I was starting to feel comfortable. But I think
what happened was, so many people are doing home testing and are

Dr. Peter Hotez

positive and are not registering with the Centers for Disease Contro l,
that we're missing that wave. Throughout this pandemic, we've
underestimated the number of new cases, generally by a factor of
four or five . I think what's happening now is they're probably being
underestimated by a factor 10 or maybe more, because of that
underreporting. So the official numbers are about 100,000 new cases
a day, which is still pretty high, but most likely, that's more like a
million cases a day. So I think that's point one.

I think point two, the CDC, you know, was aware of the importance of
getting people to understand levels of community transmission. And
they put out this hybrid map, a hybrid map of levels of community
transmission together with hospitalizations. And because the
hospitalizations are not going up that much, the map looks like what I
call the field of green, you know, meaning that it's pretty much safe
across the country, except for some areas of Maine and up in the
Northeast. I think that was misleading. I think what they should have
done is focused exclusively on maps of community transmission, not
factoring in the hospitalization, so people could accurately assess
their risk. And when you do that, well, everything's lit up in red across
the Northeast, from the mid Atlantic states up into the New England
states and then w here you are and then into Michigan and Minnesota
and then in California and the Southwest. And then we get a much
more accu rate picture of what's going on. The bottom line is the level
of transmission is so high right now, if you go to any indoor event
wi thout a mask, there's a good chance you're going to get infection or
breakthrough infection. And I think there could have been a littl e
more transparency about that.

Margaret Flinter: Well, Dr. Hotez, one I want to thank you for having been such a steady
a nd informed voice for us over these last couple of years and t w o I
think if I went back and looked at all of our conversations I would be
left with If I only knew then what we know now this constant kind of
wave of new infection has been one of the hardest things for people
to understand. But with the vaccines, what we consistently have said
to people is the chance of you being seriously ill or being hospitalized
is vastly reduced if you're vaccinated. And then we added Paxlovid as
a ---

Dr. Peter Hotez: Wel l , actually I’d say vaccinated and boosted.

Margaret Flinter: Vax – yes, I have to admit, remember to get that, fully vaccinated and
boosted.

Dr. Peter Hotez Yeah, w e still have that very poor messaging . I don't understand, we
have to stop calling fully va ccinated ful ly vaccinated, because it's not.
It's two doses and we are seeing a lot of hospitalizations among those
individuals, especially if they're a few months out. So it really depends
how far out you are from your last dose and I think we need to

Dr. Peter Hotez

emp hasize that more . Even after the third dose, with Omicron w hat
we saw is after four or five months, the protection against
hospitalizations is around 78% against emergency room visits , 66%
still good, but not nearly as good as it was, and hence the reason for
the recommendation of the second booster. And we're not pumping
out that kind of information enough. Only about 30% of the U . S .
population has gotten their first booster and now when you look at
the second booster, i t's me and a few others, right?

Marg aret Flinter: Three of us.

Dr. Peter Hotez: Yeah, the three of us. So we're all second boosted. But I think we've
not really gotten the urgency of doing that out. And then I think we
also need a longer term plan for the nation because what happens as
the i mmunity wanes from the second booster again it's still going to
hold up, okay against hospitalizations and emergency room visits, but
not as good as it could. So, is this plan now that we continuously
boost every few months knowing that the American people are just
not accepting it or do we look at a larger vaccine strategy for the
nation ? I'm of the opinion that maybe we need to look past mRNA
vaccines and look at some heterologous boosting with protein based
vaccines in order to give more robust, more dur able protection,
because what you really want is you want to keep this up for four or
five years if you can, and that's what happens with other vaccines . I
think what we don't know is, is there something about mRNA, is there
something about this unique Omi cron or BA.2.12 variant that's not
holding up as well. All that needs to be looked at a nd I've
recommended to the White House to really hold a vaccine summit of
experts to kind of track it .

Mark Masselli: Well, is there anybody doing those types of tests n ow ? Is there any
trials going on exploring this because there also seems to be sort of a
black hole here in terms of information about other vaccines that
have been developed and where they are in trials right now. It's a
mystery. I'm not sure why all this is a mystery.

Dr. Peter Hotez: Yeah, we're doing this with our vaccine in India, but there's no mRNA
vaccine in India. So we're looking at booster studies with the
AstraZeneca vaccine, followed by our vaccine or the Chinese
inactivated virus vaccine. But I think there needs to be a larger study
looking at mRNA, followed by a number of other newly available
vaccines that have come online.

Mark Masselli: What about the India results ? 30 million children have received the
vaccine, you helped develop that , wha t type of impact are you
hearing about it on the ground ?

Dr. Peter Hotez: It seems to be well accepted . It's got a great safety profile . We're not
seeing the myocarditis, which is great. And you'd expect the safety

Dr. Peter Hotez

profile to be pretty good because it's si milar to the technology used to
make the recombinant Hepatitis B vaccine that's been around for
decades a nd that's one of the best safety profiles out there. So we're
quite pleased. Now 30 million have gotten the first dose, about 10
milli on or so gotten t he second dose, that's in the 12 to 14 year olds .
We are waiting for the approval on the 5 to 11 year olds, as well as a
booster for adults. And we're also waiting for the green light from the
World Health Organization to release this for emergency use lis ting
globally, which will also make a big difference.

Margaret Flinter: That is exciting news . But we're seeing such vaccine hesitancy here
and we wonder do you see this kind of vaccine hesitancy in other
countries the way we're seeing it here or is there a different role
message communication about public health and what you need to
do in other countries than here in the U . S . ?

Dr. Peter Hotez: Well, the U . S . vaccine refusal or resistance has some unique features
to it and that is it's much more highly poli ticized. And this started
about seven or eight years ago, even before the pandemic with this
health freedom movement that says you can't tell us what to do
about vaccines. And then with COVID - 19 groups, especially in the
more conservative states and Texas and the S outhern states began to
see vaccine resistance or defiance as a form of allegiance to these
kinds of political leanings. It makes absolutely no sense. And it's so
self defeating. So I'm quite concerned about that, that that's what's
happening. And now it's spilling over into other pediatric vaccines as
well. And so I worry that this vaccine resistance refusal is not going to
halted COVID - 19 vaccinations, but it's going to become more
universal phenomenon on childhood vaccination. So I'm worried for
the future that we've not really b een able to contain the anti - vaccine
activism and sentiments very well and so this is g oing to continue to
accelerate.

Mark Masselli: And it's roiling the political environment to o obviously at a time when
m asking should be taking place indoors, we're seeing politicians sort
of back off from taking those actions. Certainly we'd like to hear your
thoughts on that. But maybe also some thoughts on how effective
masking is if it's an N - 95 and worn properly. And then if I'm out doors,
am I pretty safe outdoors, any type of transmission that happens
outdoors?

Dr. Peter Hotez: Well, if you're outdoors in a relat ively un - crowded area, it's okay. If
you're outdoors at Fenway Park and it's on a Sunday afternoon and
completely packed , t hat's a different story. But that's a little bit
unusual. Generally speaking, if you're outdoors, you don't necessarily
need a mask provided there is a really low population density where
you are. Remember the mask work both ways. It helps if you have a
m ask on to reduce the likelihood of inhaling via aerosol the COVID - 19

Dr. Peter Hotez

virus, but it works especially well if the person next to you has a mask
on and is not exhaling COVID - 19 virus. So the efficiency of masks goes
up dramatically. There's a synergy when eve ryone has a mask on,
both those who are releasing COVID - 19 particles and those who are
inhaling it. And that's what we're missing now with s o few people
mas ked .

Margaret Flinter: Dr. Hotez, the second global COVID - 19 summit was recently held and
resulted i n about $3 billion more in new financial commitments. Do
you see the funds going to the right places and the right causes from
your perspective? Were you satisfied with how that all came down?

Dr. Peter Hotez: Well, just having the acknowledgement that thi s is a global crisis and
recogniz ing that these are our next variants of concern are a rising is
really important. I think by being so slow to vaccinate in the African
countries and South Asia and Latin America early on, we missed an
opportunity to prevent that. Now we're trying to play catch up, you
k now, that also allowed the anti - vaccine groups to move in. So you're
starting to see some of those doses go un used as well. And that's why
we're hopeful for our vaccine, because it's might be better accepted,
b ecause it's a technology that parents have already used for their kids
for decades, similar to the recombinant Hepatitis B va ccine. So I do
think it'll help. We do have to make more vaccines accessible. But I
think getting more vaccine doses donated is a c ritically important
step , but it's not the only step . We've got to figure out a way to
counter this very aggressive vaccine hesitancy that it really
accelerated in the U . S . during this time of COVID - 19 but now it's
starting to contaminate low and middle in come countries. So I would
have liked to see a little more language around that in terms of what
they're planning on doing .

Mark Masselli: You know, we've moved away from having conversations about new
variants that are out there. But what are you seeing o ut there and this
sub variant is one that's spreading like wildfire across the country, but
anything new on the horizon that you're concerned about?

Dr. Peter Hotez: Well, I think I'm hoping that will start to go down as we hit and go into
June, and then t he question is, what's next . You know, in South Africa,
there is now another variation on the theme called BA.4 BA.5, will
that accelerate , I think that's one of the things I'm looking at. I'm also
a little worried about later in the summer and into the ea rly fall
b ecause historically that's when we saw a variance of concern out of
Texas and the S outhern United States within 2020 and 202 1. So I have
to believe in 2022, we will still be vulnerable to that. So the big
questions are when BA.2 goes down , when i f BA.4 BA.5 have a role in
the United States at all , and then moving in later in the summer and
fall, are we vulnerable for variant TBD - To Be Determined about that ,
and I don't think we really know b ut because we're not doing a great

Dr. Peter Hotez

vaccinating the world t hat's a concern and then over the winter as
well . So my initial hope was that 2022 would be the year where the
pandemic winds down. It d oesn't look that way. I think we have to
keep our tray tables locked in the upright position and our seats
forward and seat belts snugly fastened around our waist, at l east for
the rest of this year a nd then maybe 2023 will be the year .

Margaret Flinter: Dr. Hotez looking forward the White House has suggested that we
could see 100 million infections this fall . You have sta ted that 1 million
American deaths, which did get a lot of attention in the Times and
other places recently due to COVID was the choice. Do you think the
country has accepted that this was in fact a choice that we made and
that we're accepting infections t his high in our future or do you think
the country thinks that we're still prepared to fight this?

Dr. Peter Hotez: I don't think we've had a good accounting for fact that, you know,
after May one last year when the Biden White House announced that
anyone who wants to get a vaccine could get vaccinated, the fact that
we still had two big waves of death with Delta and Omicron, including
200,000 Americans who refuse d to get vaccinated who lost their lives.
That was an unforced error that was totally unnecessa ry. So we
haven't had that accounting of, you know, we still call it
misinformation or disi nformation. What it is, is anti - vaccine, anti -
science aggression, and it came from Members of the House Freedom
Caucus and the U . S . Congress , it came from those ampl e anti - vaccine
sentiments were amplified nightly on Fox News , and we've never
really had that truth and reconciliation that those lives did not have to
be lost. And I think that I'd like to see us come to terms with and
that's a hard conversation to have, right? Especially if you're a
scientist because all of my training as a physician scientists is you're
not supposed to talk about Republicans and Democrats and Liberals
or Conservatives, we are supposed to be beyond all that. I don't know
how you get past and let you have the discussion and it's been well
documented now by the New York Times and Axios and the Kaiser
Family Foundation, that the vaccine refusal and deaths occurred along
a partisan divide and yet we're afraid to talk about it because talking
a bout politics is considered impolite in this kind of discussion at best
or we get accused ourselves of politicizing this when I'm really doing it
to save lives.

Everyone's entitled to their conservative views, even extreme
conservative views but don't ado pt this one. And so trying to thread
that needle I think is a tough conversation to have. I think the other
tough conversation to have is around long COVID. In some ways the
million deaths is just the beginning. We're looking at a whole
generation potentia lly of Americans who, es pecially among the
unvaccinated because vaccination seems to reduce your risk of long
COVID, who are suffering from respiratory insufficiency and heart

Dr. Peter Hotez

palpitations and neurocognitive decline and gray matter brain
degeneration b ecau se of this, how do we handle that as a nation and
the fact that our health systems are not as strong as we'd like them to
be and now you're going to throw in literally millions of Americans
with long COVID and how do our health systems cope with that , how
do we manage this at the insurance level and managing people who
are going to take early retirement? Now because of disability or who
have to leave the workforce one reason or another, that's going to be
the next big thing that we're not even beginning to have that
discussion .

Mark Masselli: Yeah. And clearly the health system is not equipped to handle I think
long COVID a nd another thing it might not be equipped to talk about
or be ready to address. What are your thoughts about the likelihood
of another pa ndemic and our readiness?

Dr. Peter Hotez: Well, you know, we've had SARS in 2002. We had MERS in 2012 .
COVID - 19 was the worst of all, but we may have another big
Coronavirus pandemic because and exactly why we're seeing these
Coronavirus waves? I s it beca use of these originate from bats , is it
deforestation , or are we aggressive urbanization encroaching onto
animal habitats, is that the basis for the Ebola epidemics that we've
seen in Democratic Republic of Congo or in West Africa ? I think, you
know, we ne ed a better global system in place, especially around this
concept of One Health that is diseases transmitted from animals to
humans, which seem to be accounting for some of our worst
epidemics, which includes also Nipah virus, as I said, Ebola and also
no w this Monkey p ox , which I don't think this is going to go too far.
But that's another illness that's transmitted from animals to humans .
And as we continue to take down sections of our rainforest, people
are coming into contact with animals now for the fir st time ever.
More humans live in urban environments than rural environments.
And then climate change and I have written about this in my last book
called Preventing t he Next Pandemic , all of the big social
determinants together with climate change are som e of the b ig
drivers now.

Margaret Flinter: Well, Dr. Hotez, we wish you well, as always, thank you for joining us
today and thank you all so to our audience for being here. And
remember, you can learn more about Conversations on Health Care .
Sign up for o ur updates by going to www.chcradio.com . Dr. Hotez,
thanks so much.

Dr. Peter Hotez: Thanks for having me.

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in the know when it c omes to the facts about healthcare reform and

Dr. Peter Hotez

policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. Politics.
Lori , what have you got for us this week?

Lori Robertson: A string of unexplained hepatitis cases in children has been reported
in the U . S . and other countries. The cause is not yet known, but the
top suspect so far is a strain of adenovirus. Contrary to some social
media posts t here is no evidence that COVID - 19 vaccination is
involved. Most of the children are too young to even qualify for the
vaccine. In April, the Centers for Disease Control and Prevention and
the World Health Organization issued alerts abou t a number of
unusual severe hepatitis cases in children due to an unknown cause.
Across the globe, around 170 cases had been identified as of late
April. Hepatitis is often associated with several well known hepatitis
viruses, but the condition itself ref ers to inflammation of the liver,
which could be due to a variety of causes.

Health authorities are still investigating to understand what is causing
the rare hepatitis in these children. Many but not all of the kids have
tested positive for adenovirus , t he adenovirus family which typically
cause mild illness in healthy children. Most of the affected children
have not been vaccinated for COVID 19 , so there is no indication that
COVID - 19 vaccination could be the cause. In the U . S. t he first reports
of unusu al hepatitis in children occurred in Alabama between October
and February . Nine children were treated in the hospital for severe
hepatitis. Two kids needed liver transplants. All tested negative for
hepatitis viruses and SARS - CoV - 2 , but they were positive for
adenovirus. Physicians at the University of Alabama said that parents
do not need to panic as the cases are very rare, but people should
seek medical attention if a child shows signs of liver disease. The CDC
is now investigating 109 cases among previo usly healthy children,
including five deaths that occurred in the U . S . over the past seve n
months. Since so many of the children have te sted positive for an
adenovirus, m any investigators consider the virus the top suspect the
cause is st ill very much an o pen question.

And t hat's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenbe rg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on Conversati ons on Health Care.

Dr. Peter Hotez

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Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. It's a known
fact that the current generation of American children is more obese
than an y previous generation and at a Washington DC Community
Health Center Unity Health Care , a pediatrician was in a quandary
over how to tackle this growing health scourge. He began with a
unique solution targeted to a teen patient whose body mass index or
BMI had already landed her in the obese category. What he did was
write a prescription for getting off the bus one stop earlier on her way
to school, which made her walk the equivalent of one mile a day. Dr.
Robert Zarr of Unity Community Health Center unders tood that
without motivation to move more kids just might not do it. The
patient complied with the prescription and has moved from the obese
down to the overweight category, certainly an improvement. He then
decided to expand this program by working with t he D . C . Parks
Department mapping out all the potential walks and play area kids
have within the city's parks, mapping 380 of them so far .

Dr. Robert Zarr: How to get there, parking, is parking available, if someone's going to
d rive, bike racks, there's a s ection on pets, p ark safety ---

Margaret Flinter: Dr. Zarr writes p ark prescriptions on a special prescription pad in
English and Spanish with the words R x for outdoor a ctivity and a
schedule slot that ask when and where will you play outside this
week .

Dr. Robert Zarr: I like to listen and find out what it is my patients like to do. And then
gauge the parks I prescribe based on their interests based on t he
things they're willing to do.

Margaret Flinter: With some 40% of his patient population grappling with overweight or
obesity , he wants to make the prescription for outdoor activity
adaptable for all of his patients and adaptable for pediatricians
around the country. And h e'd like to be able to track his patients ’
activities in the parks . Rx for outdoor act ivity, partnering clinicians,
p ark administrators, pat ients and families to move more, yielding
fitter healthier young people , now that's a bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margar et Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health

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Dr. Peter Hotez

Marianne O’Hare : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
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